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Xepapadaki P, Adachi Y, Pozo Beltrán CF, El-Sayed ZA, Gómez RM, Hossny E, Filipovic I, Le Souef P, Morais-Almeida M, Miligkos M, Nieto A, Phipatanakul W, Pitrez PM, Wang JY, Wong GW, Papadopoulos NG. Utility of biomarkers in the diagnosis and monitoring of asthmatic children. World Allergy Organ J 2022; 16:100727. [PMID: 36601259 PMCID: PMC9791923 DOI: 10.1016/j.waojou.2022.100727] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 11/17/2022] [Accepted: 11/17/2022] [Indexed: 12/23/2022] Open
Abstract
Asthma imposes a heavy morbidity burden during childhood; it affects over 10% of children in Europe and North America and it is estimated to exceed 400 million people worldwide by the year 2025. In clinical practice, diagnosis of asthma in children is mostly based on clinical criteria; nevertheless, assessment of both physiological and pathological processes through biomarkers, support asthma diagnosis, aid monitoring, and further lead to better treatment outcomes and reduced morbidity. Recently, identification and validation of biomarkers in pediatric asthma has emerged as a top priority across leading experts, researchers, and clinicians. Moreover, the implementation of non-invasive biomarkers for the assessment and monitoring of paediatric patients with asthma, has been prioritized; however, only a proportion of them are currently included in the clinical practise. Although, the use of non-invasive biomarkers is highly supported in recent asthma guidelines for documenting diagnosis and supporting monitoring of asthmatic patients, data on the Pediatric population are limited. In the present report, the Pediatric Asthma Committee of the World Allergy Organization (WAO), aims to summarize and discuss available data for the implementation of non-invasive biomarkers in the diagnosis and monitoring in children with asthma. Information on the most studied biomarkers, including spirometry, oscillometry, markers of allergic sensitization, fractional exhaled nitric oxide, and the most recent exhaled breath markers and "omic" approaches, will be reviewed. Practical limitations and considerations based on both experts' opinion and critical review of the literature, on the utility of all "well-known" and newly introduced non-invasive biomarkers will be presented. A critical commentary on biomarkers' use in diagnosing and monitoring asthma during the COVID-19 pandemic, cost and availability of biomarkers in different settings and in developing countries, the differences on the biomarkers use between Primary Practitioners, Pediatricians, and Specialists and their role on the longitudinal aspect of asthma is provided.
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Affiliation(s)
- Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
- Corresponding author.
| | - Yuichi Adachi
- Department of Pediatrics, Faculty of Medicine, University of Toyam, Japan
| | | | - Zeinab A. El-Sayed
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | | | - Elham Hossny
- Pediatric Allergy, Immunology and Rheumatology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Ivana Filipovic
- University Hospital Center Dr Dragiša Mišović Hospital Pediatric Department, Serbia
| | - Peter Le Souef
- Faculty of Health and Medical Sciences, Dept of Respiratory Medicine, Child and Adolescent Health Service, University of Western Australia, Perth, Australia
| | | | - Michael Miligkos
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Antonio Nieto
- Pediatric Pulmonology & Allergy Unit Children's. Health Research Institute. Hospital La Fe, 46026, Valencia, Spain
| | - Wanda Phipatanakul
- Pediatric Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA
| | - Paulo M. Pitrez
- School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Jiu-Yao Wang
- Center for Allergy and Clinical Immunology Research, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Gary W.K. Wong
- Department of Paediatrics, The Chinese University of Hong Kong, China
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2
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Rouadi PW, Idriss SA, Bousquet J, Laidlaw TM, Azar CR, Al-Ahmad MS, Yañez A, Al-Nesf MAY, Nsouli TM, Bahna SL, Abou-Jaoude E, Zaitoun FH, Hadi UM, Hellings PW, Scadding GK, Smith PK, Morais-Almeida M, Gómez RM, Gonzalez Diaz SN, Klimek L, Juvelekian GS, Riachy MA, Canonica GW, Peden D, Wong GW, Sublett J, Bernstein JA, Wang L, Tanno LK, Chikhladze M, Levin M, Chang YS, Martin BL, Caraballo L, Custovic A, Ortega-Martell JA, Jensen-Jarolim E, Ebisawa M, Fiocchi A, Ansotegui IJ. WAO-ARIA consensus on chronic cough - Part II: Phenotypes and mechanisms of abnormal cough presentation - Updates in COVID-19. World Allergy Organ J 2021; 14:100618. [PMID: 34963794 PMCID: PMC8666560 DOI: 10.1016/j.waojou.2021.100618] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/30/2021] [Accepted: 11/12/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Chronic cough can be triggered by respiratory and non-respiratory tract illnesses originating mainly from the upper and lower airways, and the GI tract (ie, reflux). Recent findings suggest it can also be a prominent feature in obstructive sleep apnea (OSA), laryngeal hyperresponsiveness, and COVID-19. The classification of chronic cough is constantly updated but lacks clear definition. Epidemiological data on the prevalence of chronic cough are informative but highly variable. The underlying mechanism of chronic cough is a neurogenic inflammation of the cough reflex which becomes hypersensitive, thus the term hypersensitive cough reflex (HCR). A current challenge is to decipher how various infectious and inflammatory airway diseases and esophageal reflux, among others, modulate HCR. OBJECTIVES The World Allergy Organization/Allergic Rhinitis and its Impact on Asthma (WAO/ARIA) Joint Committee on Chronic Cough reviewed the current literature on classification, epidemiology, presenting features, and mechanistic pathways of chronic cough in airway- and reflux-related cough phenotypes, OSA, and COVID-19. The interplay of cough reflex sensitivity with other pathogenic mechanisms inherent to airway and reflux-related inflammatory conditions was also analyzed. OUTCOMES Currently, it is difficult to clearly ascertain true prevalence rates in epidemiological studies of chronic cough phenotypes. This is likely due to lack of standardized objective measures needed for cough classification and frequent coexistence of multi-organ cough origins. Notwithstanding, we emphasize the important role of HCR as a mechanistic trigger in airway- and reflux-related cough phenotypes. Other concomitant mechanisms can also modulate HCR, including type2/Th1/Th2 inflammation, presence or absence of deep inspiration-bronchoprotective reflex (lower airways), tissue remodeling, and likely cough plasticity, among others.
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Affiliation(s)
- Philip W. Rouadi
- Department of Otolaryngology - Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon
| | - Samar A. Idriss
- Department of Otolaryngology - Head and Neck Surgery, Eye and Ear University Hospital, Beirut, Lebanon
- Department of Audiology and Otoneurological Evaluation, Edouard Herriot Hospital, Lyon, France
| | - Jean Bousquet
- Hospital Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Department of Dermatology and Allergy, Comprehensive Allergy Center, Berlin Institute of Health, Berlin, Germany
- Macvia France, Montpellier France
- Université Montpellier, France, Montpellier, France
| | - Tanya M. Laidlaw
- Department of Medicine, Harvard Medical School, Division of Allergy and Clinical Immunology, Brigham and Women's Hospital Boston, MA, USA
| | - Cecilio R. Azar
- Department of Gastroenterology, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
- Department of Gastroenterology, Middle East Institute of Health (MEIH), Beirut, Lebanon
- Department of Gastroenterology, Clemenceau Medical Center (CMC), Beirut, Lebanon
| | - Mona S. Al-Ahmad
- Department of Microbiology, Faculty of Medicine, Kuwait University, Kuwait
| | - Anahi Yañez
- INAER - Investigaciones en Alergia y Enfermedades Respiratorias, Buenos Aires, Argentina
| | - Maryam Ali Y. Al-Nesf
- Allergy and Immunology Section, Department of Medicine, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
| | | | - Sami L. Bahna
- Allergy & Immunology Section, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | | | - Fares H. Zaitoun
- Department of Allergy Otolaryngology, LAU-RIZK Medical Center, Beirut, Lebanon
| | - Usamah M. Hadi
- Clinical Professor Department of Otolaryngology Head and Neck Surgery, American University of Beirut, Lebanon
| | - Peter W. Hellings
- KU Leuven Department of Microbiology, Immunology and Transplantation, Laboratory of Allergy and Clinical Immunology, Leuven, Belgium
- University Hospitals Leuven, Department of Otorhinolaryngology, Leuven, Belgium
- University Hospital Ghent, Department of Otorhinolaryngology, Laboratory of Upper Airways Research, Ghent, Belgium
- Academic Medical Center, University of Amsterdam, Department of Otorhinolaryngology, Amsterdam, the Netherlands
| | | | - Peter K. Smith
- Clinical Medicine Griffith University, Southport Qld, 4215, Australia
| | | | | | - Sandra N. Gonzalez Diaz
- Universidad Autónoma de Nuevo León, Hospital Universitario and Facultad de Medicina, Monterrey, NL, Mexico
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Georges S. Juvelekian
- Department of Pulmonary, Critical Care and Sleep Medicine at Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Moussa A. Riachy
- Department of Pulmonary and Critical Care, Hôtel-Dieu de France University Hospital, Beirut, Lebanon
| | - Giorgio Walter Canonica
- Humanitas University & Personalized Medicine Asthma & Allergy Clinic-Humanitas Research Hospital-IRCCS-Milano Italy
| | - David Peden
- UNC Center for Environmental Medicine, Asthma, and Lung Biology, Division of Allergy, Immunology and Rheumatology, Department of Pediatrics UNS School of Medicine, USA
| | - Gary W.K. Wong
- Department of Pediatrics, Chinese University of Hong Kong, Hong Kong, China
| | - James Sublett
- Department of Pediatrics, Section of Allergy and Immunology, University of Louisville School of Medicine, Shelbyville Rd, Louisville, KY, 9800, USA
| | - Jonathan A. Bernstein
- University of Cincinnati College of Medicine, Department of Internal Medicine, Division of Immunology/Allergy Section, Cincinnati, USA
| | - Lianglu Wang
- Department of Allergy, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing Key Laboratory of Precision Medicine for Diagnosis and Treatment of Allergic Disease, State Key Laboratory of Complex Severe and Rare Diseases, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Beijing, 100730, China
| | - Luciana K. Tanno
- Université Montpellier, France, Montpellier, France
- Desbrest Institute of Epidemiology and Public Health, UMR UA-11, INSERM University of Montpellier, Montpellier, France
- WHO Collaborating Centre on Scientific Classification Support, Montpellier, France
| | - Manana Chikhladze
- Medical Faculty at Akaki Tsereteli State University, National Institute of Allergy, Asthma & Clinical Immunology, KuTaisi, Tskaltubo, Georgia
| | - Michael Levin
- Division of Paediatric Allergology, Department of Paediatrics, University of Cape Town, South Africa
| | - Yoon-Seok Chang
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Bryan L. Martin
- Department of Otolaryngology, Division of Allergy & Immunology, The Ohio State University, Columbus, OH, USA
| | - Luis Caraballo
- Institute for Immunological Research, University of Cartagena. Cartagena de Indias, Colombia
| | - Adnan Custovic
- National Heart and Lund Institute, Imperial College London, UK
| | | | - Erika Jensen-Jarolim
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University Vienna, Austria
- The interuniversity Messerli Research Institute, Medical University Vienna and Univ, of Veterinary Medicine Vienna, Austria
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Sagamihara, Japan
| | - Alessandro Fiocchi
- Translational Pediatric Research Area, Allergic Diseases Research Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Holy See
| | - Ignacio J. Ansotegui
- Department of Allergy and Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain
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3
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Chang AB, Oppenheimer JJ, Irwin RS, Adams TM, Altman KW, Azoulay E, Blackhall F, Birring SS, Bolser DC, Boulet LP, Braman SS, Brightling C, Callahan-Lyon P, Chang AB, Cowley T, Davenport P, El Solh AA, Escalante P, Field SK, Fisher D, French CT, Grant C, Harding SM, Harnden A, Hill AT, Irwin RS, Kahrilas PJ, Kavanagh J, Keogh KA, Lai K, Lane AP, Lilly C, Lim K, Lown M, Madison JM, Malesker MA, Mazzone S, McGarvey L, Molasoitis A, Murad MH, Narasimhan M, Oppenheimer J, Russell RJ, Ryu JH, Singh S, Smith MP, Tarlo SM, Vertigan AE. Managing Chronic Cough as a Symptom in Children and Management Algorithms. Chest 2020; 158:303-329. [DOI: 10.1016/j.chest.2020.01.042] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/11/2019] [Accepted: 01/09/2020] [Indexed: 12/12/2022] Open
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Lundblad LKA, Siddiqui S, Bossé Y, Dandurand RJ. Applications of oscillometry in clinical research and practice. CANADIAN JOURNAL OF RESPIRATORY CRITICAL CARE AND SLEEP MEDICINE 2019. [DOI: 10.1080/24745332.2019.1649607] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Lennart K. A. Lundblad
- Meakins-Christie Labs, McGill University and THORASYS Thoracic Medical Systems Inc., Montréal, Québec, Canada
| | - Salman Siddiqui
- Department of Infection, Immunity and Inflammation, Leicester NIHR Biomedical Research Centre (Respiratory Theme) and University of Leicester, Leicester, UK
| | - Ynuk Bossé
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, University of Laval, Laval, Québec, Canada
| | - Ronald J. Dandurand
- CIUSSS de L’Ouest-de-L’Île-de-Montréal, Montreal Chest Institute, Meakins-Christie Labs, Oscillometry Unit and Centre for Innovative Medicine, McGill University Health Centre and Research Institute, and McGill University, Montreal, Québec, Canada
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5
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Sol IS, Kim YH, Kim S, Kim JD, Choi SH, Kim KW, Sohn MH. Assessment of within-breath impulse oscillometry parameters in children with asthma. Pediatr Pulmonol 2019; 54:117-124. [PMID: 30536749 DOI: 10.1002/ppul.24201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 10/12/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Impulse oscillometry (IOS) measures respiratory resistance and reactance during tidal breaths and is a convenient tool for evaluation of lung function. Respiratory resistance and reactance can be measured separately during inspiration and expiration (inspiratory-expiratory analysis). OBJECTIVE We investigated the differences in inspiratory-expiratory measurements obtained using IOS between children with and without asthma. METHODS We analyzed 819 subjects aged 4-18 years, including asthmatic children (n = 600) and controls (n = 219). Asthma was diagnosed in accordance with the American Thoracic Society/European Respiratory Society guideline. Spirometry and IOS were performed in all subjects. RESULTS In whole-breath analysis, the asthma group had higher resistance at 5 Hz (R5) and reactance area (AX) and lower reactance at 5 Hz (X5) than the control groups. In inspiratory-expiratory analysis, the asthma group showed increased expiratory R5 and AX and decreased expiratory X5 when compared with the control group. The absolute changes in R5, X5, and AX values between inspiration and expiration were greater in children with asthma than those in controls (0.138 ± 0.195 vs 0.102 ± 0.162, P = 0.014; -0.106 ± 0.200 vs -0.086 ± 0.434, P < 0.001 and 0.460 ± 11.63 vs 0.398 ± 2.88, P = 0.002, respectively). CONCLUSIONS Inspiratory-expiratory IOS analysis differentiated asthmatic children from control subjects, reflecting airway narrowing on expiration in pediatric asthma. The changes in R5, X5, and AX between inspiration and expiration can be a useful index for diagnosis of asthma in children without assessment of the response to a bronchodilator.
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Affiliation(s)
- In Suk Sol
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Hee Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - SooYeon Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Deok Kim
- Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea
| | - Sun Ha Choi
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Hyun Sohn
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
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Kim JD, Kim SY, Kim YH, Kim KW, Sohn MH, Sol IS. Usefulness of bronchodilator response as an index of asthma control in children. ALLERGY ASTHMA & RESPIRATORY DISEASE 2019. [DOI: 10.4168/aard.2019.7.2.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Jong Deok Kim
- Department of Pediatrics, Hanyang University Seoul Hospital, Seoul, Korea
| | - Soo Yeon Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Hee Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Hyun Sohn
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - In Suk Sol
- Department of Pedaitrics, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Korea
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7
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Sol IS, Kim YH, Park YA, Lee KE, Hong JY, Kim MN, Kim YS, Oh MS, Yoon SH, Kim MJ, Kim KW, Sohn MH, Kim KE. Relationship between sputum clusterin levels and childhood asthma. Clin Exp Allergy 2017; 46:688-95. [PMID: 26661728 DOI: 10.1111/cea.12686] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 11/27/2015] [Accepted: 12/05/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Clusterin is a sensitive cellular biosensor of oxidative stress and has been studied as a biomarker for inflammation-associated diseases. Clusterin levels in childhood asthma have not been evaluated. OBJECTIVES (1) To evaluate sputum clusterin levels in children with asthma compared to a control group. (2) To assess the relationships between sputum clusterin levels and airway inflammation, pulmonary function, and bronchial hyperresponsiveness. METHODS This study included 170 children aged 5-18 years with stable asthma (n = 91), asthma exacerbation (n = 29), or no asthma (healthy controls; n = 50). Induced sputum, pulmonary function, and methacholine challenge tests were performed. Stable asthma was classified into two groups according to the severity. Clusterin levels in sputum were measured using an enzyme-linked immunosorbent assay. RESULTS Children with stable asthma had a higher clusterin level than healthy controls [4540 (3872-5651) pg/mL vs. 3857 (1054-4369) pg/mL, P < 0.001]. The clusterin level was also more elevated in eosinophil-dominant sputum than in non-eosinophilic sputum in stable asthma [5094 (4243-6257) pg/mL vs. 4110 (1871-4839) pg/mL, P = 0.0017]. Clusterin levels were associated with asthma severity. Paradoxically, clusterin levels were lower during asthma exacerbation than in stable asthma [1838 (350-4790] pg/mL vs. 4540 (3872-5651) pg/mL, P < 0.001]. Clusterin levels were strongly correlated with the methacholine concentration that caused a 20% decrease in the forced expiratory volume in 1 s (r = -0.617, P < 0.001); there was no significant correlation between clusterin levels and other pulmonary function parameters. CONCLUSIONS AND CLINICAL RELEVANCE Clusterin levels were altered in children with stable asthma and asthma exacerbation because of its antioxidant and anti-inflammatory effects. Clusterin may be a marker that reflects airway inflammation and severity of symptoms, and it can be used in the assessment and management of childhood asthma.
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Affiliation(s)
- I S Sol
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Y H Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Y A Park
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - K E Lee
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - J Y Hong
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - M N Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Y S Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - M S Oh
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - S H Yoon
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - M J Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - K W Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - M H Sohn
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - K E Kim
- Department of Pediatrics, Severance Hospital, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
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Increased sputum levels of thymus and activation-regulated chemokine in children with asthma not eosinophilic bronchitis. Allergol Immunopathol (Madr) 2017; 45:220-226. [PMID: 28238403 DOI: 10.1016/j.aller.2016.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 11/16/2016] [Accepted: 12/03/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Thymus and activation-regulated chemokine (TARC), a member of the CC chemokine family, plays a crucial role in Th2-specific inflammation. We aimed to determine the concentration of sputum TARC in children with asthma and eosinophilic bronchitis (EB) and its relation with eosinophilic inflammation, pulmonary function, and bronchial hyper-responsiveness. METHODS In total, 90 children with asthma, 38 with EB, and 45 control subjects were enrolled. TARC levels were measured in sputum supernatants using an ELISA. We performed pulmonary function tests and measured exhaled fractional nitric oxide, eosinophil counts in blood, and sputum and serum levels of total IgE in all children. RESULTS Sputum TARC levels were significantly higher in children with asthma than in either children with EB (p=0.004) or the control subjects (p=0.014). Among patients with asthma, sputum TARC concentration was higher in children with sputum eosinophilia than in those without sputum eosinophilia (p=0.035). Sputum TARC levels positively correlated with eosinophil counts in sputum, serum total IgE levels, exhaled fractional nitric, and the bronchodilator response. Negative significant correlations were found between sputum TARC and FEV1/FVC (the ratio of forced expiratory volume in one second and forced expiratory vital capacity) or PC20 (the provocative concentration of methacholine causing a 20% decrease in the FEV1). CONCLUSION Elevated TARC levels in sputum were detected in children with asthma but not in children with EB. Sputum TARC could be a supportive marker for discrimination of asthma from EB in children showing characteristics of eosinophilic airway inflammation.
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9
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Kim SY, Kim JY, Han YK, Kim JD, Sol IS, Park YA, Kim YH, Kim KW, Sohn MH, Kim KE. Clinical implication of exhaled breath temperature measurement in pediatric asthma. ALLERGY ASTHMA & RESPIRATORY DISEASE 2017. [DOI: 10.4168/aard.2017.5.3.147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Soo Yeon Kim
- Department of Pediatrics, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Yoon Kim
- Department of Pediatrics, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Ki Han
- Department of Pediatrics, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Deok Kim
- Department of Pediatrics, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - In Suk Sol
- Department of Pediatrics, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Young A Park
- Department of Pediatrics, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Hee Kim
- Department of Pediatrics, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Department of Pediatrics, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Hyun Sohn
- Department of Pediatrics, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu-Earn Kim
- Department of Pediatrics, Institute of Allergy, Brain Korea 21 PLUS Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
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10
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Kwon JW, Song WJ, Kim MH, Lim KH, Yang MS, Jung JW, Lee J, Suh DI, Shin YS, Kim SH, Kim SH, Lee BJ, Cho SH. The KAAACI Standardization Committee Report on the procedure and application of fractional exhaled nitric oxide measurement. ALLERGY ASTHMA & RESPIRATORY DISEASE 2017. [DOI: 10.4168/aard.2017.5.4.185] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Jae-Woo Kwon
- Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
| | - Woo-Jung Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Min-Hye Kim
- Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Kyung-Hwan Lim
- Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea
| | - Min-Suk Yang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul, Korea
| | - Jae-Woo Jung
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jeongmin Lee
- Department of Pediatrics, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Yoo Seob Shin
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea
| | - Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang-Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Byung-Jae Lee
- Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Heon Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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11
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Rao DR, Phipatanakul W. An Overview of Fractional Exhaled Nitric Oxide and Children with Asthma. Expert Rev Clin Immunol 2016; 12:521-30. [PMID: 26757849 DOI: 10.1586/1744666x.2016.1141049] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Asthma is the most common pediatric chronic disease and is characterized by lung inflammation. Fractional exhaled nitric oxide (FeNO) is thought to reflect the presence of eosinophilic airway inflammation, and is an easy, non-invasive test that has held promise in providing additional objective data. However, not all studies have shown a clinical benefit in the use of FeNO to guide management of asthma in children. This review will describe the results of the most recent studies examining the use of FeNO in the diagnosis and treatment of asthma in infants, preschool-aged children and in school-aged children. It will aid the clinician in providing a clinical context in which FeNO may be most useful in treating pediatric asthma.
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Affiliation(s)
- Devika R Rao
- a Division of Respiratory Medicine, Department of Pediatrics , University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Wanda Phipatanakul
- b The Channing Division of Network Medicine , Brigham and Women's Hospital , Boston , MA , USA.,c Division of Allergy & Immunology.,d Boston Children's Hospital.,e Harvard Medical School , Boston , MA , USA
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12
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Mandaliya PH, Morten M, Kumar R, James A, Deshpande A, Murphy VE, Gibson PG, Whitehead B, Robinson P, Mattes J. Ventilation inhomogeneities in children with congenital thoracic malformations. BMC Pulm Med 2015; 15:25. [PMID: 25887144 PMCID: PMC4417263 DOI: 10.1186/s12890-015-0023-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 03/11/2015] [Indexed: 05/28/2023] Open
Abstract
Background Congenital thoracic malformations (CTM) are rare lung lesions that are managed with surgical resection or active surveillance. The objective of this study was to comprehensively assess large and small airway function in children with CTM who underwent lobectomy in early life. We hypothesise that sensitive measures of lung function will demonstrate residual impairments in CTM compared to healthy children. Methods Nitrogen lung clearance index (LCI), reactance and resistance (X5Hz and R5Hz), forced expiratory volume in 1 s and forced vital capacity (FEV1 and FVC) were prospectively measured in 10 children with CTM (mean age/SD: 7.6/1.3) who had undergone surgical resection in early life and in 17 healthy children (mean age/SD: 4.8/0.4). Total lung capacity (TLC) was also conducted in children older than 7 years of age with CTM (n = 8). Results Mean LCI was 8.0 (95% CI 7.5 to 8.5) in the CTM group and 7.3 (95% CI 7.0 to 7.6) in healthy children (p = 0.016). Mean X5Hz was −0.44kPa/l/s (95% CI −0.58 to −0.31) in the CTM group and −0.31kPa/l/s (95% CI −0.35 to −0.27) in healthy children (p = 0.02). Mean Z score for X5Hz was −2.11 (95% CI −3.59 to −0.63) in the CTM group and −0.11 (95% CI −0.55 to 0.33) in healthy children (p = 0.0008). Mean FEV1 was 1.21 L (95% CI 0.97 to 1.45) in the CTM group and 1.02 L (95% CI 0.90 to 1.15) in healthy children (p = 0.22). Mean % predicted FEV1 was 83% (95% CI 74 to 92) in the CTM group and 97% (95% CI 87 to 107) in healthy children (p < 0.05). Mean % predicted TLC in CTM children was 121.3% (95% CI 88.45 to 154.1). Mean LCI was inversely correlated with height z-scores in the CTM group (rs = −0.88, p = 0.002) but not in healthy children (rs = 0.22, p = 0.4). Conclusions Children with CTM have impaired lung function as demonstrated by the significant differences in LCI, reactance and FEV1 but not FVC, resistance and TLC. These findings may be of clinical relevance as ventilation inhomogeneities are closely correlated with somatic growth in this study. Electronic supplementary material The online version of this article (doi:10.1186/s12890-015-0023-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Payal H Mandaliya
- Experimental & Translational Respiratory Medicine, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia. .,Paediatric Respiratory and Sleep Medicine Department, Newcastle Children's Hospital, Newcastle, NSW, Australia.
| | - Matthew Morten
- Experimental & Translational Respiratory Medicine, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia.
| | - Rajendra Kumar
- Paediatric Surgery Department, Newcastle Children's Hospital, Newcastle, NSW, Australia.
| | - Alan James
- Surgery Department, John Hunter Hospital, Newcastle, NSW, Australia.
| | - Aniruddh Deshpande
- Paediatric Surgery Department, Newcastle Children's Hospital, Newcastle, NSW, Australia.
| | - Vanessa E Murphy
- Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia.
| | - Peter G Gibson
- Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia.
| | - Bruce Whitehead
- Paediatric Respiratory and Sleep Medicine Department, Newcastle Children's Hospital, Newcastle, NSW, Australia.
| | - Paul Robinson
- Paediatric Respiratory Department, Children's Hospital at Westmead, Sydney, NSW, Australia.
| | - Joerg Mattes
- Experimental & Translational Respiratory Medicine, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia. .,Paediatric Respiratory and Sleep Medicine Department, Newcastle Children's Hospital, Newcastle, NSW, Australia.
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13
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Abstract
PURPOSE OF REVIEW To review recent developments in the mechanisms of chronic cough. RECENT FINDINGS Although cough prevalence is similar across the world, there are significant regional differences in the diseases associated with cough. This may represent regional differences in diet, environmental exposure, and diagnostic assessment and labelling. Cough can be reliably measured using several validated questionnaires and objective tools that monitor cough frequency and cough reflex sensitivity. Cough with eosinophilic bronchitis responds to anti-inflammatory therapy with corticosteroids and montelukast. The absence of airway hyperresponsiveness may be because of the release of a bronchoprotective mediator, prostaglandin E2. Cough with neutrophilic bronchitis is associated with rhinitis and gastroesophageal reflux disease. Laryngeal hypersensitivity (LHS) is an important new concept that explains cough mechanisms, identifies potentially new pharmacotherapies that target neural pathways and also transient receptor channels, and demonstrates how behavioural therapies can be effective in refractory cough. The concept also explains symptoms in a variety of related syndromes such as vocal cord dysfunction. SUMMARY New insights into cough mechanisms that focus on LHS help explain cough symptoms and the place of effective therapies including speech pathology intervention and neuromodulators.
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14
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Song WJ, Kwon JW, Kim EJ, Lee SM, Kim SH, Lee SY, Kim SH, Park HW, Chang YS, Kim WK, Shim JY, Seo JH, Kim BJ, Kim HB, Song DJ, Jang GC, Jang AS, Park JW, Yoon HJ, Lee JS, Cho SH, Hong SJ. Clinical application of exhaled nitric oxide measurements in a korean population. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2014; 7:3-13. [PMID: 25553257 PMCID: PMC4274466 DOI: 10.4168/aair.2015.7.1.3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 10/25/2013] [Indexed: 12/31/2022]
Abstract
Nitric oxide (NO) is a biologic mediator of various physiologic functions. Recent evidence suggests the clinical utility of fractional exhaled NO (FeNO) as a biomarker for assessing asthma and other respiratory diseases. FeNO methodologies have been recently standardized by international research groups and subsequently validated in several Korean population studies. Normal ranges for FeNO have been reported for various ethnic groups, and the clinical utility has been widely evaluated in asthma and various respiratory diseases. Based on current evidence including most of Korean population data, this position paper aims to introduce the methodological considerations, and provide the guidance for the proper clinical application of FeNO measurements in Korean populations.
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Affiliation(s)
- Woo-Jung Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ji-Won Kwon
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Eun-Jin Kim
- Allergy TF, Department of Immunology and Pathology, Korea National Institute of Health, Cheongwon, Korea
| | - Sang-Min Lee
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - So-Yeon Lee
- Department of Pediatrics, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Suwon, Korea
| | - Sang-Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Heung-Woo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. ; Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Woo Kyung Kim
- Department of Pediatrics, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Jung Yeon Shim
- Department of Pediatrics, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ju-Hee Seo
- Department of Pediatrics, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Byoung-Ju Kim
- Department of Pediatrics, Korea Cancer Center Hospital, Seoul, Korea
| | - Hyo Bin Kim
- Department of Pediatrics, Hae-undae Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Dae Jin Song
- Department of Pediatrics, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Gwang Cheon Jang
- Department of Pediatrics, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - An-Soo Jang
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Jung-Won Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Ho-Joo Yoon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Joo-Shil Lee
- Allergy TF, Department of Immunology and Pathology, Korea National Institute of Health, Cheongwon, Korea
| | - Sang-Heon Cho
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Soo-Jong Hong
- Department of Pediatrics, Childhood Asthma Atopy Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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15
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Sol IS, Kim YH, Lee HS, Kim MJ, Han YK, Park YA, Kim KW, Sohn MH, Kim KE. Heterogeneity of asthma according to systemic inflammatory pattern in children. ALLERGY ASTHMA & RESPIRATORY DISEASE 2014. [DOI: 10.4168/aard.2014.2.3.165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- In Suk Sol
- Department of Pediatrics, Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 2 1 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Hee Kim
- Department of Pediatrics, Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 2 1 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Seon Lee
- Department of Pediatrics, Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 2 1 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Min Jung Kim
- Department of Pediatrics, Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 2 1 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Ki Han
- Department of Pediatrics, Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 2 1 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Young A Park
- Department of Pediatrics, Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 2 1 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Department of Pediatrics, Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 2 1 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Hyun Sohn
- Department of Pediatrics, Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 2 1 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu-Earn Kim
- Department of Pediatrics, Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 2 1 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
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16
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Kim YH, Park HB, Kim MJ, Kim HS, Lee HS, Han YK, Kim KW, Sohn MH, Kim KE. Fractional exhaled nitric oxide and impulse oscillometry in children with allergic rhinitis. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2013; 6:27-32. [PMID: 24404390 PMCID: PMC3881396 DOI: 10.4168/aair.2014.6.1.27] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 03/21/2013] [Accepted: 04/03/2013] [Indexed: 12/23/2022]
Abstract
Purpose Airway inflammation, bronchial hyper-responsiveness (BHR), and bronchodilator response
(BDR) are representative characteristics of asthma. Because allergic rhinitis (AR) is a
risk factor for asthma development, we evaluated these 3 characteristics in AR using
measurement of fractional exhaled nitric oxide (FeNO), a methacholine challenge test
(MCT), and impulse oscillometry (IOS). Methods This study included 112 children with asthma (asthma group), 196 children with AR (AR
group), and 32 control subjects (control group). We compared pulmonary function
parameters and FeNO levels among the 3 groups. The AR group was subdivided into 2
categories: the AR group with BHR and the AR group without, and again pulmonary function
and FeNO levels were compared between the 2 subgroups. Results FeNO levels were more increased in the AR and asthma groups than in the control group;
within the AR group, FeNO was higher in the AR group with BHR than in the AR group
without. The BDR was more increased in the AR group than in the control group when
percent changes in reactance at 5 Hz (Δ X5) and reactance area (Δ AX) were
compared. In the AR group, however, there was no difference in Δ X5 and Δ
AX between the AR group with BHR and the AR group without. Conclusions Reversible airway obstruction on IOS and elevated FeNO levels were observed in children
with AR. Because elevated FeNO levels can indicate airway inflammation and because
chronic inflammation may lead to BHR, FeNO levels may be associated with BHR in AR. IOS
can be a useful tool for detecting lower airway involvement of AR independent of BHR
assessed in the MCT.
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Affiliation(s)
- Yoon Hee Kim
- Department of Pediatrics and Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Bin Park
- Department of Pediatrics and Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Min Jung Kim
- Department of Pediatrics and Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hwan Soo Kim
- Department of Pediatrics and Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Seon Lee
- Department of Pediatrics and Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Yoon Ki Han
- Department of Pediatrics and Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung Won Kim
- Department of Pediatrics and Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Hyun Sohn
- Department of Pediatrics and Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu-Earn Kim
- Department of Pediatrics and Institute of Allergy, Severance Biomedical Science Institute, Brain Korea 21 Project for Medical Science, Yonsei University College of Medicine, Seoul, Korea
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